tbuckley/cabot-search huggingface dataset:
Abstract P659: Cluster Analysis of County-Level Cardiovascular Disease Mortality in the United States
Authors: Yanfang Xu, Ye Shen, Hui Huang, Donglan Zhang
Journal: Circulation (2023)

Introduction: In the United States, cardiovascular disease (CVD) mortality has been declining since 1980s. However, the decline in CVD mortality is not uniform across regions and may show different trajectories that are driven by place-based social determinants of health (SDOH) such as physical and built environment, social-cultural environment, and health care system. We conducted a cluster analysis of county-level CVD mortality and SDOH indicators from 2009 to 2018. Hypothesis: We test the hypothesis that CVD mortality in US counties show different trajectories that can be grouped by clusters, and within each cluster, there are different SDOH variables that predict CVD mortality. Methods: We linked the Centers for Disease Control and Prevention's CVD mortality data with the Agency for Healthcare Research and Quality's public database on SDOH using county identifiers. CVD mortality rate was calculated as the number of deaths per 100,000 people in each county. There were 179 SDOH variables included in the model, classified into five different domains: the biological, behavioral, built and physical environment, health care system, and sociocultural environment domain. We employed a linear mixed-effects model fitted with a doubly penalized likelihood to induce sparsity for parameter estimation and effect selection. Results: We identified three clusters among a total of 3,136 counties. Overall, 1,182 counties were identified as cluster 1 that showed a consistent decline of CVD mortality over the past decade. The most important driving factor of CVD mortality in cluster 1 was population distribution - the percentage of population aged 15-17 (coefficient=7.032). Secondly, 1,116 counties were identified as cluster 2 that showed a decline between 2009 and 2012, and then a steady increase in CVD mortality after 2012. Within cluster 2, the number of mild drought months was the most predictive factor of CVD mortality (coefficient= -1.065), and the percentage of adults reporting no leisure-time physical activity was the second important predictor (coefficient= 0.646). Finally, 838 counties were identified as cluster 3 that showed a flattening trend in CVD mortality. Within cluster 3, the total number of obstetrics and gynecology, generalist, and primary care hospital residents plays the most important role (coefficient = -25.537). Each cluster has unique pattern and distinctive associations between certain SDOH variables and CVD mortality. Conclusions: In conclusion, we identified three intrinsic clusters that showed distinguishing trajectories of CVD mortality during the past decade. The SDOH indicators most predictive of CVD mortality were different within each cluster. This study suggests that place based SDOH drive substantial differences in CVD outcomes across regions.
Abstract P432: Statin Initiation for Primary Prevention and Dose Intensity According to Age in the Women’s Health Initiative
Authors: Michael Bancks, Sarah A Gaussoin, Dan Beavers, Adam S Bress, Chris Gillette, Bernhard Haring, Longjian Liu, David J Maron, Lindsay M Reynolds, Aladdin H Shadyab, Mara Z Vitolins
Journal: Circulation (2023)

Introduction: Over 50% of US adults older than 75 live free of atherosclerotic cardiovascular disease (ASCVD) and diabetes (DM), yet data on incident statin use among this population are lacking. Our objective was to assess statin initiation by age among the Women’s Health Initiative cohort free of ASCVD and DM at baseline (1993). Hypothesis: Statin initiation is higher at older ages and differs by race/ethnicity. Methods: Exclusions were statin use at baseline, known ASCVD, DM, and no follow-up after baseline. Self-reported medication use was assessed in 1996 and 2008. Specific statin and dose prescribed at the time of initiation were identified using National Drug Codes and determined statin intensity, defined by the ACC/AHA guidelines. We estimated the adjusted association between age group (&lt;65, 65-74, and ≥75) and statin initiation and assessed for heterogeneity by race/ethnicity. We also assessed statin dose at the time of initiation. Results: Over 12 years of follow-up, 27% of 99,631 women free of ASCVD and DM at baseline initiated a statin; initiation was lower with older age (Table). This association remained after adjustment for ASCVD risk factors and did not differ by race/ethnicity (p for interaction &gt;0.5). Moderate intensity dose was most common at statin initiation overall, and moderate and high intensity dose were both lower with older age. Conclusion: Of women free of ASCVD and DM, women older than 75 were least likely to start a statin and most likely to start low intensity statin therapy at initiation than younger women. We identified a potential clinical gap for investigation: whether lower overall use of statins and lower intensity statin therapy among older women are associated with preventable ASCVD.
Abstract P336: Early Metabolic Imbalance in Young Adults is a Hidden Risk Factor for Midlife Cardiovascular Disease: CARDIA 35-year Follow Up
Authors: David P Cistola, Alok K Dwivedi
Journal: Circulation (2023)

Introduction: The U.S. population includes a prevalent group of teens and young adults with early metabolic imbalance or EMI. This insidious condition includes markers of insulin resistance, particularly its interaction with adiposity, as well subclinical inflammation and oxidative stress. High circulating insulin compensates for insulin resistance in tissues, keeping fasting glucose, triglycerides and HDL within normal limits. Thus, individuals with EMI do not meet the criteria for metabolic syndrome or prediabetes. Previously, we reported that compensatory hyperinsulinemia in young adults is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD), based on an analysis of 30-year data from CARDIA: Coronary Artery Risk Development in Young Adults. Here, we expand the analysis to include other components of EMI and the latest 35-year follow up data. Hypothesis: In young adults, EMI increases the risk for midlife ASCVD. Methods: This is a retrospective cohort study of CARDIA. The parent study enrolled 5,114 participants, ages 18-30 at baseline. In this retrospective analysis, the baseline exclusion criteria were hyperglycemia, hypertriglyceridemia, low HDL, diabetes, CVD, pregnancy or fasting &lt;8 hours, yielding 3,292 participants without metabolic syndrome or prediabetes. The data were analyzed using Cox proportional hazard regression in Stata 17.0 and JMP 16.2. The primary exposures were markers of insulin resistance, inflammation and oxidative stress at baseline; the covariates were the 2019 ACC/AHA risk factors for ASCVD: increased waist circumference (WC), hypertension, poor fitness, LDL ≥160, nicotine use (serum cotinine), family history of premature ASCVD, race, sex and estimated glomerular filtration rate (eGFR) &lt;60. The primary outcome was time to incident ASCVD (or censor), defined as any fatal or nonfatal MI, coronary revascularization, acute coronary syndrome, CHF, stroke, TIA, carotid or peripheral artery disease. Cox results were reported as hazard ratio (HR) and Harrell’s c-statistic (c). Results: All reported Cox models met the proportional hazards and linearity assumptions. Model 1 includes the ACC/AHA risk factors, yielding a Harrell’s c of 0.714. For WC, the HR for tertile 3 vs. 1 was 2.1, 95% CI 1.4, 3.1, p&lt;0.0001. Cox Model 2 replaces WC with a categorical variable with both WC and HOMA2-IR, a marker of insulin resistance. The HR for both measures in tertile 3 vs. both in tertile 1 was 2.1, 95% CI: 1.3, 2.5, p&lt;0.0001; Harrell’s c increased to 0.728. Cox model 3 adds markers of inflammation and oxidative stress to Model 2, increasing C to 0.735. In models 2 and 3, high WC was a significant risk factor only in combination with high HOMA2-IR, indicative of effect modification. Conclusion: After accounting for canonical risk factors, early metabolic imbalance in otherwise healthy young adults in CARDIA is a hidden risk factor for midlife ASCVD.
Abstract 28: Proteomic Signatures of Adiposity in Middle-Aged Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Bige Ozkan, Ebenezer K Aryee, Jingsha Chen, Justin B Echouffo Tcheugui, Kuni Matsushita, Kari E North, Christie M Ballantyne, Bing Yu, Amil M Shah, Elizabeth Selvin, Josef Coresh, Chiadi E Ndumele
Journal: Circulation (2023)

Background: Excess adiposity is linked to adverse cardiovascular outcomes via direct and indirect effects on metabolic pathways. There is limited large-scale data assessing proteomic signatures of adiposity. Methods: We quantified 4,955 plasma proteins using SomaLogic v4.0 in stored plasma samples of 9,940 ARIC Visit 2 participants (1990-92, mean age: 57±6 years, 55% women, 22% Black adults, 28% with obesity). We used linear regression and Bonferroni-corrected p-values to identify proteins associated with body mass index (BMI) in 2/3 discovery and 1/3 validation samples. We performed additional analyses to assess key pathways associated with obesity. Results: In the discovery sample (28% with obesity), after adjusting for age, sex, race-center, eGFR, 1,312 proteins were significantly associated with BMI. After further adjustments for clinical and lifestyle risk factors (Figure), 975 proteins were significantly associated with BMI (p&lt;10 -5 ). There were 713 proteins confirmed in the validation sample (p&lt;0.05/975). Among the confirmed proteins, there were &gt;500 proteins that did not have previously described BMI associations in population studies (including serine protease HTRA1, seizure 6-like protein) as well as proteins with known BMI associations (including leptin, fatty acid binding proteins, insulin-like growth factor-binding proteins). Acute phase response, atherosclerosis signaling, hepatic fibrosis, pancreatic cancer and lipid metabolism were among the top biological pathways overrepresented by the proteins associated with BMI (Figure). The upstream regulators of these proteins included interleukins (IL-17A, IL-13, IL-4), as well as tumor necrosis factor (TNF), which was activated. Conclusion: We discovered several novel proteins associated with adiposity and confirmed previously identified proteins. Alteration in the plasma proteome related to adiposity is linked to differential regulation of inflammatory and metabolic pathways independent of cardiovascular risk mediators.
Abstract P421: Eggs as Part of a Healthy Eating Pattern Are Not Adversely Associated With Dyslipidemia in the Framingham Offspring Study
Authors: Ioanna Yiannakou, Melanie M Mott, Xinyi Zhou, Martha R Singer, Lynn L Moore
Journal: Circulation (2023)

Background: For decades, dietary guidelines have recommended restricting egg consumption out of concern about the high content of dietary cholesterol and potential effects on LDL cholesterol levels and, in turn, cardiovascular risk. However, the evidence supporting these recommendations has been increasingly questioned. Objective: To examine the association of egg consumption with plasma lipid levels and risk of dyslipidemia in adults in the Framingham Offspring Study, and to determine whether these effects are modified by other dietary factors. Methods: We included 1,852 adults aged 30-64 years with available 3-day food records, and without prevalent CVD or use of lipid-lowering or glucose-lowering medications. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of elevated fasting LDL-C and triglycerides after adjusting for confounding. Analysis of covariance models were used to estimate sex-specific mean plasma levels of total cholesterol, LDL, the ratio of LDL:HDL, and triglycerides associated with categories of egg intake. Confounding factors retained in the final models included age, BMI, and other dietary factors. Stratified analyses were used to evaluate effect modification by several dietary factors. Findings: Over approximately 6 years of follow-up, 372 adults developed new-onset elevated LDL and 306 adults developed new-onset elevated triglycerides levels. Overall, those with higher egg consumption (vs. lower) had very similar intakes of other healthy foods at baseline (e.g., whole grains, fruits, vegetables, dairy, and fish). Men and women consuming ≥5 eggs per week (vs. &lt;0.5) had no increased risk of elevated LDL (HR=0.85, 95% CI: 0.59-1.22) or triglycerides (HR=1.25, 95% CI: 0.83-1.86). In fact, men with higher egg intakes (≥5 vs. &lt;0.5 per week) had a total cholesterol level that was 8.6 mg/dL lower, an LDL level that was 5.9 mg/dL lower, and a log-transformed triglyceride level that was 0.13 units lower (p&lt;0.05 for all differences) after 4 years of follow-up. Further, participants with higher egg consumption in combination with higher fiber intake had lower levels of all lipids (p&lt;0.05 for total cholesterol, LDL, and LDL:HDL for the category of higher egg &amp; higher fiber vs. lower egg &amp; lower fiber). Moreover, consumption of &gt;5 eggs/week (vs. &lt;0.5) combined with either higher intakes of total fish or fiber was also associated with statistically significant reductions in LDL levels. Conclusions: This study suggests that higher egg intakes had no adverse effects on serum lipids in healthy adults and may be beneficial as part of a healthy eating pattern.
Abstract 48: Associations of Diet and Physical Activity With Biological Aging Among US Adults: National Health and Nutrition Examination Survey 1999-2018
Authors: Aline Thomas, Daniel W Belsky, Yian Gu
Journal: Circulation (2023)

Background: Behavioral lifestyle factors are promising for prevention of numerous diseases and mortality risk by contributing to overall healthy ageing. Healthy diet and regular physical activity have been associated with longer telomere length, indicating younger biological aging. More recently, algorithm-based measurements of biological aging, which integrate information across panels of molecular or clinical indicators, have proven both more technically reliable and more precise in their predictions of morbidity and mortality than telomere length. The aim of this study was to examine the association of diet, physical activity, and their interaction with biological ageing measured by PhenoAge blood chemistry algorithm. Methods: This study included adult participants (≥20 years-old) from the National Health and Nutrition Examination Survey (NHANES), 1999-2018. We evaluated adherence to a Mediterranean diet (MeDi) and level of leisure time physical activity (LTPA) using standard instruments. We measured biological aging using the PhenoAge algorithm, developed using data from NAHNES III (1988-1994) and validated as a predictor of morbidity/mortality in the NHANES data we analyzed. We defined PhenoAge advancement as the difference between biological age derived from eight blood biomarkers and chronological age, with higher score indicating being biologically older. We evaluated the associations of MeDi and LTPA with PhenoAge in adjusted linear regressions. We explored synergies between these two health behaviors and heterogeneity in their associations across strata of sex age, gender, and body mass index (BMI). Results: In total, 38,617 participants (mean age 47.1 years, 51% women) were included. Both higher adherence to MeDi and higher level of LTPA were associated with lower PhenoAge advancement, in mutually adjusted model controlled for demographic, socioeconomic and lifestyle variables (β = 0.15 SD [95% CI, -0.18; -0.11] for high vs low tertile of adherence to MeDi, and β = 0.12 SD [-0.15; -0.09] for high LTPA level vs sedentarity). The associations of diet and physical activity phenotypes with biological aging were independent and additive (p-interaction &gt;0.05). Stratified analyses indicated consistent significant associations across strata of age, gender, and BMI, although stronger associations were observed among women and participants with normal weight than among their respective counterparts for MeDi (p-interaction = 0.001 and 0.04, respectively) and among older participants for LTPA (p-interaction &lt;0.001). Sensitivity analysis using the Healthy Eating Index 2015 did not change the results. Conclusion: Healthy diet and regular physical activity are independently associated with lower clinically defined biological aging, regardless of age, sex, and BMI category.
Abstract P570: The Association of Ideal Cardiovascular Health With Self-Reported Health in Black American Women
Authors: Faith E Metlock, Sarah Addison, Amaris Williams, Songzhu Zhao, Joshua J Joseph, Timiya S Nolan
Journal: Circulation (2023)

Introduction: Black American women suffer disproportionately from an increased burden of cardiovascular health (CVH) risk factors, earlier onset of cardiovascular disease (CVD), and higher CVD mortality when compared to their White women. The Partnering in Negating Statistics (P.I.N.S.) for Black Women Initiative is an academic-community-government partnership aimed at uplifting Black women to achieve total health and wellness through the provision of education, access to resources, and partnership in science. Women’s community wellness events have operationalized the P.I.N.S. Initiative mission since 2021, drawing Black women and their families to take part in resources like cardiovascular disease screenings (AHA’s Life’s Simple 7 [LS7] and Life’s Essential 8 [LE8]) and education. The study presented herein examined the association of ideal cardiovascular health (ICH) with self-reported health among Black American women who attended the community wellness events. Methods: Community wellness events focusing on Black women occurred in 2021 and 2022. At these events, a battery of measurements including CVH metrics (blood pressure, glucose, cholesterol, body mass index [BMI], physical activity, smoking, diet and sleep duration) and self-reported health(poor, fair, good, excellent) were collected from participants who chose to participate in biometric screening. The associations between LS7 (range 0-14)/LE8 (range 0-100) with self-reported health were tested using multinomial logistic regression controlling for age, income, and education. Results: One-hundred and twenty-three Black American women with complete LS7 and self-reported health data were included in the analysis 2021 and 2022, of those 63 of participants in 2022 had LE8 data. The mean age of participants was 50 (SD 14), 66%, 23%, 7% and 2% were employed, retired, unemployed and students, 76% and 15%, were enrolled in private insurance, Medicaid/Medicare and 15% had no insurance. Sixty-nine percent had educational attainment ≥ college. In fully adjusted analyses, a 1-unit increase (range 4-13) in LS7 was associated with a 34% lower odds of fair vs. excellent self-reported health (OR 0.66, 95%CI: 0.46, 0.96,p=0.0281). A 1-unit increase in LE8 (range 38-91) was associated with a 13% lower odds of fair vs. excellent self-reported health (OR 0.87, 95%CI: 0.78, 0.98, p=0.0258). Conclusion: Attainment of higher ICH was associated with lower odds of fair vs. excellent self-reported health among Black American women. This finding is important in community-based health interventions and clinical trial recruitment in historically underrepresented populations including Black women, as individuals who appropriately recognize their health status may be more likely to engage in clinical and community-based research to improve health.
Abstract 51: Better Sleep Health is Associated With Greater Adherence to Lifestyle Modification During a 12-month Behavioral Weight Loss Intervention
Authors: Christopher E Kline, Christopher C Imes, Susan M Sereika, Daniel J Buysse, Bonny Rockette-Wagner, Zhadyra Bizhanova, Lora E Burke
Journal: Circulation (2023)

Introduction: Consistent evidence suggests that poor sleep may impede weight loss efforts; however, the impact of poor sleep on lifestyle modification during attempted weight loss is unclear. Purpose: To examine the relationship between sleep health and measures of lifestyle modification in a sample of adults who participated in a 12-month behavioral weight loss intervention. Methods: Adults (N=125) with overweight or obesity (50.3±10.6 years, 91% female, 81% White) participated in a 12-month behavioral weight loss intervention. Assessments occurred at baseline, 6 months, and 12 months. Six dimensions of sleep were included in our operationalization of sleep health: regularity, satisfaction, alertness, timing, efficiency, and duration. Sleep dimensions were assessed using validated questionnaires and actigraphy, with values dichotomized into ‘good’ and ‘poor’ sleep. A composite sleep health score was calculated based upon the count of the ‘good’ individual dimensions (range: 0-6), with higher scores indicating better sleep health. Measures of lifestyle modification included attendance at group intervention sessions, daily adherence to caloric intake goals (% of days), and change in average daily moderate-vigorous physical activity (MVPA). Linear mixed modeling was used to examine the relationship between baseline and 6-month sleep health and lifestyle modification during the subsequent 6-month interval with adjustment for age, gender, bed partner, and race. The composite sleep health score and individual sleep health dimensions were evaluated in separate models. Results: Mean sleep health was 4.5±1.1 (mean±standard deviation) at baseline and 4.5±1.2 at 6 months; from 0-6 months and 6-12 months, participants attended 79.4±15.0% and 62.3±32.3% of the group intervention sessions, adhered to caloric intake goals on 35.6±23.3% and 21.1±23.3% of the days, and changed MVPA by 8.7±13.6 min/day and -3.7±13.6 min/day. Better sleep health was associated with higher rates of attendance at group intervention sessions (b=2.71, SE=1.29; P=.038), greater adherence to caloric intake goals (b=4.60, SE=1.34; P&lt;.001), and a trend for greater change in MVPA (b=1.41, SE=0.82; P=.088). Associations with lifestyle modification outcomes were observed with the following individual sleep dimensions (each P&lt;.05): regularity with attendance and caloric intake, satisfaction with caloric intake, and duration with MVPA. Conclusions: Better sleep health was associated with greater adherence to lifestyle modification during a 12-month behavioral weight loss intervention. Whether improving sleep health prior to or during a weight loss intervention facilitates better lifestyle modification outcomes merits examination. Support: NIH R01HL107370.